Provider Demographics
NPI:1205069515
Name:HALSTEAD, LE ROY J (RN)
Entity type:Individual
Prefix:MR
First Name:LE ROY
Middle Name:J
Last Name:HALSTEAD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2003 KELSEY BAY CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-5346
Mailing Address - Country:US
Mailing Address - Phone:757-376-6882
Mailing Address - Fax:757-558-3633
Practice Address - Street 1:2003 KELSEY BAY CT
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-5346
Practice Address - Country:US
Practice Address - Phone:757-376-6882
Practice Address - Fax:757-558-3633
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
VA0001156312163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No163W00000XNursing Service ProvidersRegistered Nurse